Confronting fear using exposure and response prevention for anorexia nervosa: A randomized controlled pilot study

Abstract

Objective: Anorexia nervosa (AN) is a severe illness with high rates of relapse. Exposure and Response Prevention for AN (AN-EXRP) is a new approach that specifically addresses maladaptive eating behavior by targeting eating-related fear and anxiety. The aim of this study was to evaluate AN-EXRP as an adjunctive strategy to improve eating behavior during weight restoration, at a pivotal moment when treatment goals shift toward relapse prevention.

Method: A randomized controlled trial was conducted to compare AN-EXRP with a comparison condition, Cognitive Remediation Therapy (CRT). Hospitalized patients with AN (n = 32) who had achieved weight restoration to a BMI > 18.5 kg/m(2) received 12 sessions of either AN-EXRP or CRT. Outcome was assessed by change in caloric intake in an objective assessment of eating behavior.

Results: The average test meal caloric intake of participants who received AN-EXRP increased from 352 ± 263 kcal at baseline to 401 ± 215 kcal post-treatment, while that of participants who received CRT decreased from 501 ± 232 kcal at baseline to 424 ± 221 kcal post-treatment [t(28) = 2.5, p = .02]. Improvement in intake was significantly associated with improvement in eating-related anxiety (Spearman's ρ = 0.40, p = .03).

Discussion: These data demonstrate that AN-EXRP, compared to a credible comparison intervention, is associated with better caloric intake in a laboratory meal over time in AN. Additional studies are required to determine whether incorporation of these techniques into a longer treatment program leads to enduring and clinically significant change.

Trial registration: ClinicalTrials.gov NCT00627341.

Keywords: anorexia nervosa; anxiety; cognitive behavior therapy; controlled trial; eating disorders; exposure and response prevention; exposure therapy; psychotherapy; randomized trial; treatment.

Figure 1. CONSORT Diagram

Figure 2. Change in test meal caloric intake in the Exposure and Response Prevention for AN (AN-EXRP) and Cognitive Remediation Therapy (CRT) groups

Change in caloric intake was measured as intake in a laboratory meal at Week 4 – Week 0 for each individual. The figure shows mean change per group; bars represent 95% confidence intervals.